How your GP is "incentivised" and why you might not be getting the care you need

How your GP is "incentivised" and why you might not be getting the care you need

Had difficulty getting an appointment, had difficulty getting treatment, had difficulty as your doctor has not been attended training on your issues - this might be why...

It has been another one of those weeks and I was on my GP's website trying to find a way of contacting them as I had no luck making an appointment this week.

I saw a link to an article on the sidebar of the GP website which took me to an article which mentioned QOF payments to GP's and this comment about delays in GP payments on this incentive scheme due to computer glitches:

Dr Beth McCarron Nash of the GPC said...

‘We are hearing more and more about these problems caused by the fragmentation after 1 April [and] are pushing NHS England on this issue, but unfortunately we are hearing that many practices are struggling with cash flow as a result and have run into accountancy difficulties. It is just unacceptable for small businesses. How are we meant to provide a service under this stress?’

Small Business? - and here was me thinking the NHS was a health service, emphasis on service - silly me!

This peaked my interest so googled QOF payments and found this government article:

and the first few lines read (my comments in <> ):


The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice.

<the doctors surgery receives payment based on the following criterea - they get pounds for points, although unlike your tesco or sainsbury's loyalty points they get many pounds per point - for more info on this see article:>

The QOF contains four main components, known as domains. The four domains are: Clinical Domain, Organisational Domain, Patient Experience Domain and Additional Services Domain. Each domain consists of a set of achievement measures, known as indicators, against which practices score points according to their level of achievement. The 2012/13 QOF measured achievement against 148 indicators; practices scored points on the basis of achievement against each indicator, up to a maximum of 1,000 points.

* clinical: the domain consists of 96 indicators across 22 clinical areas (e.g. coronary heart disease, heart failure, hypertension) worth up to a maximum of 669 points.

* organisational: the domain consists of 42 indicators (worth up to 254 points) across six organisational areas – records and information; patient communication; education and training; quality and productivity; practice management and medicines management.

* patient experience: the domain consists of one indicator (worth up to 33 points) that relates to length of consultations.

* additional services: the domain consists of nine indicators (worth up to 44 points) across four service areas – cervical screening, child health surveillance, maternity service and contraceptive services.


So - of the 1,000 points a doctor can earn - only 33 of these are awarded for patient experience, and most appear to be based on admin, business practices and getting the right kind of patient on your books.

Why are surgeries struggling with cash-flow? - They receive their budget from the government at the same time each year - so why are they cash strapped when their Bonus scheme is delayed? - perhaps the amount of money from the government is not enough, GP surgeries relying on the bonus scheme, dangerous - this means services are likely to be skewed towards fitting the bonus requirement, rather than meeting patient needs.

ooh - coming over all conspiracy theorist - time for a cuppa ;-)

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10 Replies

  • Hi - very impressive post, thanks.

  • I am already "piggy in the middle" between my GP and the hospital. The cardiologist wants a special blood test, (probably expensive) but told me to get it done at the surgery. My GP is very cross as it comes out of his budget and if the hospital want it, they should do it. Meanwhile, I'm still waiting......

  • I have a very simialr problem - just got long awaited blood tests through that I had to fight my doctor for and surprise surprise the specialist was right and got a letter today asking me to call the doctor as soon as possible - if only they had done it months ago when first asked to do so and not ping ponging me about the place.

    But we are not the only ones, and from what I read on this site there are many good doctors out there who struggle against funding cuts to give their patients the best possible care and then there are those that turn up tuesday afternoon and bedgrudge the time away fromthe golf course.

    it sucks to be with one of the naff ones, but you just have to keep pushing them - wishing you the best of luck with yours


  • Yeah. I'm not attracted to this break up idea.

    Once over NHS was the biggest employer with 750 000 staff. Now it's PCTs or whatever it is now it's behaving disjointedly. Can't keep us in the same area long. I was in Wessex, Hants, Eastleigh and Winchester, University of Southampton. And I'm so confused any or all of that may be wrong! Tinkering hasn't solved any problems. Just as changing the British Airways logo didn't solve efficiency issues (why would it?)

    Railtrack became Network Rail

    Post office parcels became consignia.

    English Nature became Natural England and I think it doesn't even exist now

    need I go on?

    The result is poor for us but I feel for the people who have to try to operate the system. It's on a par with what's happening with Atos

    To misquote Sir Humphrey Appleby (Yes Minister) " something must be done, we are doing something however inappropriate, there fore we will get the votes"

    Dangerous Dogs act still isn't doing what it was intended - how could it? Dogs cant read.

    Puts soapbox away, calms down with earthworm Daquiri

  • earthworms in daiquiri? - sounds.....novel?? :-)

  • You've never tried it???? :P (hic) :P

  • It is true that GPS create services to fit QOF but also the QOF requirements, and others like DESs, are created to improve services- such as a new DES (ES) to support reduction in unplanned admission to hospital- by improving services available outside of hospital.

  • The department of health gives money to nhs England who gives money to CCGs (instead of the now nonexistent PCTs), and to GPs. The CCGs are made up of GPs and commissioners, who support GPs to meet NHS England's requirements including QOF and DESs

  • Proves my point. I hadn't realised PCTs no longer exist. Confooosed - ok nowt new.

    My GP still exists

    :P :P

  • My point is that NHS England want to improve services for people with long term conditions. Everyone who works for the nhs (all the different parts) have to show how the plans they make will contribute to the nhs constitution.

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